Ho hanyetsa likokoana-hloko (AMR) e se e le e 'ngoe ea litšokelo tse kholo bophelong ba sechaba lefatšeng ka bophara.

Phuputso ea bohlokoa e phatlalalitsoeng hoLancethakanngoa horeMafu a limilione tse 1.27 ka 2019 a bakiloe ka ho toba ke ho hanyetsa likokoana-hloko tsa baktheria (AMR), ha e le haufi le hoMafu a limilione tse 5 a ne a amahanngoa le AMR ea baktheriaHoa makatsa,73% ea mafu a bakoang ke AMR a bakiloe ke likokoana-hloko tse tšeletseng feela., e totobatsang tlhoko e potlakileng ea tlhokomelo e sebetsang hantle, thibelo ea tšoaetso, tlhokomelo ea likokoana-hloko le tlhahlobo e potlakileng.

Har'a likokoana-hloko tsena, libaktheria tse tharo tse mpe tsa Gram li tšoaneloa ke tlhokomelo e khethehileng:

• · Klebsiella pneumoniae(KPN)
• · Acinetobacter baumannii(Aba)
• · Pseudomonas aeruginosa(PA)

Diphedi tsena di ntse di hanela carbapenems ka ho eketsehileng—e leng motheo wa kalafo bakeng sa ditshwaetso tse ngata tse mpe tsa Gram-negative—mme di ananelwa lefatsheng ka bophara e le dikokwana-hloko tsa bohlokwa.

WHO e Khetholla Likokoana-hloko tsena e le tsa Bohlokoakapa Lintho tsa Bohlokoa

TheLethathamo la Likokoana-hloko tsa Bohlokoa tsa Baktheria tsa WHO (BPPL) 2024e hlwaya dibaktheria tse hanyetsanang le dikokwana-hloko tse hlokang matsete a potlakileng ho di-diagnostic tse ntjha, kalafo, diente le mawa a thibelo ya tshwaetso.

Har'aBohlokoa/HolimoBohlokoalikokoana-hloko ke:

• · E hanela CarbapenemAcinetobacter baumannii(LEKHALA)
• · E hanela CarbapenemPseudomonas aeruginosa(CRPA)
• · Enterobacteriales (CRE) e hananang le Carbapenem, ho kenyeletsoaKlebsiella pneumoniae(CRKP)

WHO e boetse e hatisa hore ho sebetsana le likokoana-hloko tsena ho hloka mokhoa o akaretsang oa ho kopanyatlhahlobo e potlakileng, tlhokomelo, tlhokomelo ea likokoana-hloko (AMS), le thibelo le taolo ea tšoaetso (IPC)ho e-na le ho itšetleha feela ka nts'etsopele ea lithibela-mafu tse ncha.

Tataiso ea Machaba e Totobatsa Bohlokoa ba Tlhahlobo e Potlakileng

Ho loantša AMR ho hloka ho fetang lithibela-mafu tse sebetsang hantle—ho itšetlehile ka tlhahlobo e nepahetseng le e nakong.

TheMorero oa Lefatše oa WHO oa Ketso ea ho Hanela Likokoana-hlokoe hlwaya ho matlafatsa bokgoni ba laboratori le ho atolosa phihlello ya tlhahlobo ya boleng e le dintho tsa bohlokwa tsa bohlokwa bakeng sa ho ntlafatsa tlhokomelo le ho ntlafatsa tshebediso ya dikokwana-hloko.

Ha re haha ​​hodima leano lena,Leano la WHO la ho Hlahloba ho Hanyetsa Likokoana-hloko (2024)e totobatsa tlhahlobo e potlakileng e le sesebelisoa sa bohlokoa ho:

• · Tšehetsa tlhokomelo ea likokoana-hloko (AMS)
• · Tataiso ka kalafo e nepahetseng le e thibelang likokoana-hloko ka nako e nepahetseng
• · Nolofatsa thibelo le taolo ea tšoaetso (IPC)
• · Matlafatsa tlhokomelo ea AMR
• · Ntlafatsa ho lemoha le ho arabela seoa sa seoa
• 

Ka ho tšoanang,Mokhatlo oa Mafu a Tšoaetsanoang oa Amerika (IDSA)e khothaletsa tlhahlobo e potlakileng ea limolek'hule, moo e fumanehang, ho khetholla likokoana-hloko tsa baktheria le mekhoa ea ho hanyetsa pejana, e lumellang lingaka ho ntlafatsa phekolo ea likokoana-hloko le ho fokotsa ho pepesehela lithibela-mafu tse pharaletseng ho sa hlokahaleng.

TheMokhatlo oa Europe oa Likokoana-hloko tsa Bongaka le Mafu a Tšoaetsanoang (ESCMID)e boetse e khothaletsa ho tsebahatsa kapele libaktheria tse hlahisang Gram-negative tse hlahisang carbapenase ho nolofatsa ho kenngwa tshebetsong ha mehato ya taolo ya tshwaetso le kalafo e nepahetseng ya dikokwana-hloko.

Hammoho, dikgothaletso tsena tsa matjhaba di matlafatsa molaetsa o tshwanang:Tlhahlobo e potlakileng ea limolek'hule e se e fetoha karolo ea bohlokoa ea tsamaiso ea sejoale-joale ea AMR.

Ho utloisisa KPN, Aba le PA

Klebsiella pneumoniae (KPN)

K. pneumoniaeke sesosa se seholo sa pneumonia e amanang le tlhokomelo ea bophelo bo botle, tšoaetso ea mali, tšoaetso ea moroto le sepsis.

E hanana le CarbapenemK. pneumoniaeHangata e na le liphatsa tsa lefutso tsa carbapenemase ho kenyeletsoa: KPC, NDM, OXA-48-like le IMP.

Mefuta e nang le kokoana-hloko e feteletseng e ka kopanya kokoana-hloko e eketsehileng le ho hanyetsa meriana e mengata, e leng se bakang liphephetso tse kholo tsa phekolo.

Acinetobacter baumannii (Aba)

A. baumanniie mamella maemo a thata haholo mme e kgona ho phela hodima dibaka tsa tikoloho nako e telele.

E amana haholo le:

• · Ho phatloha ha ICU
• · Pneumonia e amanang le ho hema (VAP)
• · Tšoaetso ea mali
• · Litšoaetso tse amanang le sesebelisoa

Bokhoni ba eona bo ikhethang ba ho fumana lintho tse etsang hore e se ke ea hanyetsana le carbapenem bo entse hore e se ke ea hanyetsana le carbapenem.A. baumanniie 'ngoe ea likokoana-hloko tse thata ka ho fetisisa sepetlele ho li phekola.

Pseudomonas aeruginosa (PA)

P. aeruginosake kokoana-hloko e nkang monyetla eo hangata e tšoaetsang bakuli ba kulang haholo le ba nang le sesole sa 'mele se fokolang.

Ho hanyetsa ka hare ho mmele, ho ikamahanya le maemo ka potlako le ho thehwa ha biofilm ho kenya letsoho ho tshwaetsong e sa feleng le ho eketsa ho hanyetsa carbapenem lefatsheng ka bophara.

Phetisetso Libakeng tsa Tlhokomelo ea Bophelo

Likokoana-hloko tsena tse hanyetsanang le meriana e mengata li fetisoa haholo-holo ka:

• · Lisebelisoa tsa bongaka tse silafetseng le libaka tsa tikoloho
• · Matsoho a basebetsi ba tlhokomelo ea bophelo bo botle
• · Bakuli ba kolone kapa ba tšoaelitsoeng
• · Maro a tsoang ho hema
• · Lisebelisoa tse hlaselang tse kang li-ventilator le li-catheter

Ho ea kaLitsi tsa Taolo le Thibelo ea Mafu tsa US (CDC), ho fumanoa ha laboratori esale pele hammoho le tlhokomelo ea likokoana-hloko le mehato e matla ea thibelo ea tšoaetso ke habohlokoa bakeng sa ho fokotsa phetiso ea likokoana-hloko tse hanyetsanang le meriana e mengata tse amanang le tlhokomelo ea bophelo bo botle.

Liphephetso tsa Kalafo

Mekhoa ea phekolo e ntse e fokotseha haholo.

Liphephetso tsa hajoale li kenyelletsa:

• · Ho eketsa khanyetso ea carbapenem
• · Ho fumaneha ha meriana e mecha ea ho loantša likokoana-hloko ho haella
• · Chefo e amanang le polymyxins
• · Khanyetso e hlahellang khahlanong le li-agent tse ncha

Ka lebaka leo, litataiso tsa machaba li khothaletsa ho fumana bopaki ba likokoana-hloko ka nako e nepahetseng ho tšehetsa phekolo e reretsoeng ea likokoana-hloko neng kapa neng ha ho khoneha.

Hobaneng ha ho Lemohuoa ha Limolek'hule ka Potlako ho le Bohlokoa

Teko ea setso le ea ho pepesehela likokoana-hloko hangata li hlokaLihora tse 48–72pele liphetho tse ka sebelisoang li fumaneha.

Tlhahlobo e potlakileng ea limolek'hule e ka khutsufatsa nako ena haholo ka ho khetholla likokoana-hloko le liphatsa tsa lefutso tsa bohlokoa tsa ho hanyetsa ka nako e le 'ngoe, e leng se nolofalletsang pejana:

• · Kalafo e nepahetseng ea ho loantša likokoana-hloko
• · Mekhoa ea thibelo ea tšoaetso
• · Liqeto tsa taolo ea lithibela-mafu
• · Tlhokomelo ea likokoana-hloko tse hanyetsanang

Tharollo ea Multiplex PCR bakeng sa ho Etsa Liqeto ka Potlako tsa Bongaka

Ho tšehetsa ho tsebahatsa kapele likokoana-hloko tsa bohlokoa tsa Gram-negative tsa bongaka le mekhoa ea ho hanyetsa carbapenem,Sete ea ho lemoha liphatsa tsa lefutso tse ngata tsa Macro le Micro-Test ea KPN, Aba, PA le Drug Resistance Genes Multiplexe lemoha ka nako e le 'ngoe:

Likokoana-hloko tse reretsoeng: Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa 

Lijini tsa Carbapenemase: KPC, NDM, OXA-48, IMP

Likarolo tsa Bohlokoa

• · Ho lemoha ka ho toba ho tsoa lisampoleng tsa sekhohlela
• · Ha ho hlokahale ntlafatso ea setso nako e telele
• · Kutloisiso ea tlhahlobo:LoD 1000 CFU/mL 
• · Liphetho li fumaneha kaMetsotso e 35–50 
• · E lumellana le li-platform tsa PCR tsa nako ea sebele

Ka ho fana ka tlhahlobo e potlakileng ea limolek'hule ea likokoana-hloko le matšoao a ho hanyetsa, teko e ka tlatsana le mesebetsi ea setso ea baeloji le ho tšehetsa ho etsoa ha liqeto tsa bongaka pejana.

Ho Sebetsa 'Moho Khahlanong le AMR

Ho hanyetsa likokoana-hloko ho ke ke ha hlōloa ka lithibela-mafu tse ncha feela.

TheWHO, IDSA, ESCMIDleCDCkamehla e hatisa hore taolo e sebetsang ea AMR e hloka ho kopanngoa ha:

• · Tlhahlobo e potlakileng
• · Tlhokomelo ea likokoana-hloko
• · Thibelo le taolo ea tšoaetso
• · Tlhokomelo ea laboratori
• · Ketso ea bongaka e etsoang ka nako

Ha lilaboratori lefatšeng ka bophara li ntse li tsoela pele ho matlafatsa karabelo ea tsona ea AMR, tlhahlobo e potlakileng ea limolek'hule tse ngata e ka bapala karolo ea bohlokoa ho ts'ehetsa liqeto tsa kalafo tse thehiloeng bopaking le ho thusa ho fokotsa ho ata ha likokoana-hloko tse hanyetsanang.

Litšupiso

1. Bathusi-'moho ba ho Hanela Likokoana-hloko.Moroalo oa lefats'e oa ho hanyetsa likokoana-hloko tsa baktheria ka 2019. Lancet.2022.

2. Mokhatlo oa Lefatše oa Bophelo.Morero oa Lefatše oa Ketso oa ho Hanela Likokoana-hloko.2015.

3. Mokhatlo oa Lefatše oa Bophelo.Lethathamo la Likokoana-hloko tsa Bohlokoa tsa Baktheria tsa WHO la 2024. 

4. Mokhatlo oa Lefatše oa Bophelo.Bohato ba ho Hlahloba ho Hanela Likokoana-hloko.2024.

5. Mokhatlo oa Mafu a Tšoaetsanoang oa Amerika (IDSA).Tataiso ea 2024 mabapi le Kalafo ea Litšoaetso tsa Gram-Negative tse Hanelang Likokoana-hloko. 

6. Mokhatlo oa Europe oa Likokoana-hloko tsa Bongaka le Mafu a Tšoaetso (ESCMID).Tataiso ea Taolo ea Litšoaetso tse Bakiloeng ke Bacilli ea Gram-Negative e Hanelang Meriana e Mengata. 

7. Litsi tsa Taolo le Thibelo ea Mafu tsa US (CDC).Litšokelo tsa ho Hanela Lithibela-mafu United States.